Dental props, tongue retractors (positioners), lip and cheek retractors and saliva evacuation devices are commonly used in dental and oral surgery practice. Such devices facilitate dental and oral surgery procedures by improving visibility and increasing the available working space within a patient's mouth, and by removing saliva, blood, debris and the like from the patient's mouth which would otherwise accumulate and interfere with dental operations and generally increase patient discomfort.
Dental props are devices which are inserted into the patient's mouth between upper and lower teeth to keep the mouth opened in a fixed position while the dentist is working in the patient's mouth. Normally the teeth on one side of the mouth engage the dental prop while the dentist is working on the teeth on the opposite side of the mouth. Dental props are desirable, particularly in order to enhance the efficiency of the dentist, so the dentist does not have to continually remind the patient to keep the mouth open at a certain angle and also so that the dentist does not have to be concerned with the patient inadvertently biting his or her fingers or the dental instruments. Props also act as comfortable rests for the patient. In the past, various appliances have been used to isolate or open parts of the mouth to facilitate the performing of dental services. In addition to dental props, expansion forceps have been used to hold the patient's jaws open.
Another problem encountered during dental procedures is that the oral cavity is constantly being filled with body fluids, such as saliva. If these body fluids are not removed, they may adversely effect many of the dental procedures that require a dry field for success. Also, a buildup of saliva or body fluid in the mouth has a negative impact on the patient's comfort. The proximity of the oral soft tissues, such as the tongue, cheek and lip, to the field of work may make it difficult to perform those dental procedures also requiring a dry field. Therefore, the success of many operative dental procedures requires the removal of body fluids and soft tissues from the field of work.
Saliva removal is further necessitated because dental procedures frequently involve substances, such as mercury amalgam particles, which are unhealthy to ingest and would otherwise be swallowed by a patient if not removed by suction. Several devices are known in the dental and oral surgery professions for positioning a patient's mouth and tongue during treatment and/or removing saliva and debris therefrom. Most of the known devices do not contain an integral saliva evacuation device. As a result, an additional tube or hook must be inserted into the oral cavity which further impairs viewing and makes the proper and effective positioning of the evacuation device difficult and cumbersome for the dental professional who, in this regard, often requires the help of a dental assistant.
An additional area of concern is that, in dentistry, it has been the practice to use a dental lamp in combination with a dental mouth mirror to assist viewing while performing work in the oral cavity. The dental lamp is a light source providing a large beam of light which may be focused in the general area of a patient's mouth. Thereafter, a dental mirror is used to indirectly view inaccessible areas of the mouth, or to retract the tongue or cheek in order to view an area directly. Such technique has not been entirely satisfactory. A dentist's hands and/or instruments often shade the area which is being viewed, thereby requiring the dentist to assume an awkward position so as not to shade the area being viewed. During an oral examination or dental cleaning, where each tooth and various other structures are observed and manipulated, the dental lamp must constantly be adjusted, resulting in considerable time loss and frustration.
It is also known in the art to use lip and/or cheek spreaders or retractors. By retracting the cheek or lips the dental professional is able to increase the viewable area of the oral cavity.
Another impediment to the practice of dentistry relates to the human tongue. The tongue extends from an elevated arc area near the throat toward the tongue tip at the anterior aspect of the mouth. The arc area of the tongue must be depressed to obtain a good view of the mouth, and control of the tongue has proven to be problematic in both conscious and unconscious patients. In conscious patients the tongue can become fatigued when the patient attempts to hold the tongue away from the area of concern for extended periods of time. Additionally, the tongue is involved in several involuntary responses such as swallowing or the gag reflex. The unconscious patient is simply unable to keep the tongue away from the area where the dental professional is working and is also susceptible to all of the same involuntary actions as the conscious patient.
If the tongue moves into the area of the oral cavity where the dental professional is working, several problems can occur. Not only might the dental professional's view be impaired, but also the tongue may be injured by a dental instrument. It is therefore important to keep control of the tongue's position in the mouth.
Several appliances are know in the art which attempt to solve one or more of the above-mentioned problems. One such appliance which is used for isolating parts of the mouth is the rubber dam which consists of a flexible piece of material having holes disposed therein to permit placement down over the teeth into surface contact with the gums so that the teeth protrude through the holes in the rubber dam. The rubber dam does not have a flexible frame having cheek and tongue deflectors attached thereto or a provision for saliva removal.
There are also several known appliances which serve as dental props. One such device consists of an oval shaped frame having lip deflectors attached thereto. It does not have provision for saliva ejection or tongue deflection. Moreover, it may only be used to isolate the anterior teeth.
Another dental prop is shown in U.S. Pat. No. 2,023,288 which is adjustable by means of a wedge having beveled notches. The wedge is forced between opposed jaw engaging members to open the patient's mouth. The beveled notches engage a lug on one of the jaw engaging members to secure the wedge in place. However, the use of notches and a lug in this dental prop provides for only incremental adjustment. Also, the beveled notches provide for smooth adjustment only when the wedge is inserted further into the mouth. This means that, were the patient's mouth to be closed only slightly, the wedge has to be completely retracted. The fact that the patient first has to open his mouth in order for the wedge to be removed and repositioned means that the dental procedure has to be interrupted, thereby prolonging patient discomfort. Moreover, this dental prop includes two pieces. This poses the risk that one of the pieces may be lost by the dentist or swallowed by the patient. Furthermore, the wedge and the jaw engaging members form a barrier on one side of the patient's mouth which obstructs the view of the working area of the mouth for an assistant, where assistance is required during the dental procedure.
U.S. Pat. No. 3,090,122 discloses a device which is molded of a waterproof or liquid impervious flexible material such as rubber or plastic. The device has a central depressed portion in which saliva pools and is collected. The marginal edges of the device are adapted to provide a sealing engagement with the roof and floor of the mouth, with the device being between the patient's teeth and tongue. The patient may experience a gagging sensation with the device due to the sealing engagement of the device with the roof of the mouth. The saliva and debris are collected through a pair of apertures positioned basically in the center of the device. With the patient's head typically tilted backward, saliva and debris tends to pool or collect along the floor of the mouth or lower edge portion of the dental device. With the saliva and debris collecting apertures disposed somewhat centrally on the device, saliva removal may not necessarily be very efficient. Moreover, this device is a relatively high cost item, and as with the rubber dam, must be effectively sterilized prior to each use thereof. Finally, when the dentist uses an auxiliary vacuum evacuator, rubber or plastic material tends to be drawn against the evacuator blocking the opening.
U.S. Pat. No. 2,220,674 discloses a device with a cheek-engaging convex portion having a pair of spaced diverging trough portions that form a U-shaped trough section on which the teeth rest. Devices fitting this general description continue to be sold and used. These devices are simple in design and relatively inexpensive; however, if the patient is unable or unwilling to cooperate due to age, mental disability, or response to medication, the dental practitioner or an assistant will have difficulty getting the device to remain in place. Attempts to hold the device in place may result in impaired visibility of, and access to, the mouth. Furthermore, the person holding the device in place is subject to injury from biting or contact with devices used by the dental practitioner.
Regarding lighting and mirror appliances, U.S. Pat. No. 3,638,013 discloses a fiber optic lighting system having a fiber optic cable which transmits light from a distant light source to illuminate the area of the mouth in which an instrument is being used. Unfortunately, prior art combinations of a fiber optic cable with a dental mouth mirror have proven to be unacceptable. Such combinations have been cumbersome and significantly limited the maneuverability of the mouth mirror. Moreover, such combinations are not readily transportable and can only be used in suitably equipped dental operatory.
None of the above patents provide for suctioning the soft palate region of the mouth behind the dental appliance. Nor do they disclose illumination of the mouth cavity at selected sites. Usually the dental assistant must suction and evacuate the mouth with a hand-held suction device. The mouth illumination devices as previously discussed are provided at a fixed location in the mouth and thus do not provide for changeable illumination of certain portions of the mouth cavity.
The prior art also has long testified to the need for a dental device which would serve to readily withdraw or expand the lips and cheeks and retract the tongue from their normal position in order to facilitate both a visual and physical access to the teeth as well as to other anatomical areas such as the gingivae surrounding the teeth and the palate and throat, and simultaneously aid in maintaining a clean, dry field of operation without the assistance of an auxiliary person.